The test-retest reliability of anatomical co-ordinate axes definition for the quantification of...

Journal of Human Kinetics volume 35/2012, 15-25 DOI:10.2478/v10078-012-0075-8 15 Section I – Kinesiology

1 - Division of Sport, Exercise and Nutritional Sciences, University of Central Lancashire. 2 - School of Psychology, University of Central Lancashire. 3 - School of Life Sciences, University of Hertfordshire. 4 - Faculty of Health, University of Staffordshire.

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Authors submitted their contribution of the article to the editorial board.

Accepted for printing in Journal of Human Kinetics vol. 35/2012 on December 2012.

The Test-Retest Reliability of Anatomical Co-Ordinate Axes

Definition for the Quantification of Lower Extremity Kinematics

During Running

by

Jonathan Sinclair1, Paul JohnTaylor2, Andrew Greenhalgh3, 4, Christopher James

Edmundson1, Darrell Brooks1, Sarah Jane Hobbs1

Three-dimensional (3-D) kinematic analyses are used widely in both sport and clinical examinations.

However, this procedure depends on reliable palpation of anatomical landmarks and mal-positioning of markers between

sessions may result in improperly defined segment co-ordinate system axes which will produce in-consistent joint

rotations. This had led some to question the efficacy of this technique. The aim of the current investigation was to assess

the reliability of the anatomical frame definition when quantifying 3-D kinematics of the lower extremities during

running. Ten participants completed five successful running trials at 4.0 m·s-1 ± 5%. 3-D angular joint kinematics

parameters from the hip, knee and ankle were collected using an eight camera motion analysis system. Two static

calibration trials were captured. The first (test) was conducted prior to the running trials following which anatomical

landmarks were removed. The second was obtained following completion of the running trials where anatomical

landmarks were re-positioned (retest). Paired samples t-tests were used to compare 3-D kinematic parameters quantified

using the two static trials, and intraclass correlations were employed to examine the similarities between the sagittal,

coronal and transverse plane waveforms. The results indicate that no significant (p>0.05) differences were found

between test and retest 3-D kinematic parameters and strong (R2≥0.87) correlations were observed between test and

retest waveforms. Based on the results obtained from this investigation, it appears that the anatomical co-ordinate axes

of the lower extremities can be defined reliably thus confirming the efficacy of studies using this technique.

Key words: Gait analysis, running, kinematics, repeatability, motion analysis

Introduction

Three-dimensional (3-D) kinematic

analyses are used widely in both sport and clinical

examinations. The computer aided movement

analysis in a rehabilitation group (Leo, 1995)

proposed recommendations for anatomical

landmarks used to define the anatomical frame of

the lower extremities. This was borne out of the

work by Cappozzo et al. (1995) and was designed

to increase the efficacy of future studies in

modelling lower extremity segments.

The calibrated anatomical systems

technique (CAST) offers the ability to model each

body segment in six degrees of freedom

(Cappozzo et al., 1995). The CAST technique

involves the quantification of an anatomical co-

ordinate system axes for each segment via the

identification of anatomical landmarks through

external palpation which is then calibrated with

respect to corresponding arrays of technical

tracking clusters (Richards and Thewlis, 2008).

This technique is currently considered to be the

gold standard for 3-D kinematic analyses

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16 The test-retest reliability of anatomical co-ordinate axes definition

Journal of Human Kinetics volume 35/2012 http://www.johk.pl

(Richards and Thewlis, 2008; Sinclair et al., 2012).

However, anatomical landmark identification by

manual palpation and corresponding marker

placement is not an error-free technique, and mal-

positioning of anatomical landmarks may cause

improperly defined segment co-ordinate system

axes which will result in erroneous joint rotations

(Kabada et al., 1989; Ferber et al., 2002). Analyses

using 3-D motion capture systems are now

common place in biomechanics research and

reliability is of paramount importance,

particularly in epidemiological or aetiological

analyses when clinical decisions are made.

In sport and clinical research, where

multiple participants are examined or patient’s

gait must be assessed over time, it is essential to

ensure that the identification of the relevant joint

centres is reproducible. Reliable segment co-

ordinate system axes are important as they

provide reliable and consistent movement

interpretation. Kadaba et al. (1989) and Della

Croce et al. (1999) suggest that even small

differences in the orientation and placement of

markers forming the segment co-ordinate system

can lead to sizeable differences in the calculation

of joint angular parameters which may in turn

inhibit the interpretation of the collected data.

Therefore analyses utilizing 3-D motion

capture techniques clearly necessitate the accurate

palpation of anatomical landmarks to produce

repeatable, segmental anatomical co-ordinate

systems (Della Croce et al., 2005). However, Della

Croce et al. (2005) suggest it is difficult to place

anatomical markers in exactly the same location

and the determination of their location lacks

accuracy and precision. Previous investigations

have been conducted examining the reliability of

3-D kinematic techniques (McGinley et al., 2009;

Rothstein and Echternach, 1993; Pohl et al., 2010);

however, the majority of these have examined

either inter-session or inter-assessor reliability

between sessions. Whilst these factors are clearly

important to the efficacy of 3-D kinematic

protocols they do not allow the reliability of

anatomical frame definition to be examined

effectively as different (inter-session) dynamic

data is being applied to the static anatomical

reference trials obtained from each session.

Therefore, despite the number of investigations

utilizing 3-D analysis, there is currently a paucity

of research investigating the true test-retest

reliability in defining the segment anatomical co-

ordinate system and the influence that differences

in anatomical frame definition may have on the 3-

D kinematic parameters measured during the

stance phase of running.

The aim of the current investigation is

therefore to assess the reliability of the anatomical

frame definition when quantifying 3-D kinematics

of the lower extremities during running.

Methods

Participants

Ten participants (7 males and 3 females)

volunteered to take part in this investigation (age

22.4 ± 2.05 years; body height 179.4 ± 6.2 cm; body

mass 79.1 ± 8.2 kg; shoe size 7-9 UK). All were

injury free at the time of data collection and

provided written informed consent in accordance

with the declaration of Helsinki. Ethical approval

for this project was obtained from the University

of Central Lancashire School of Psychology ethics

committee.

Procedures

An eight camera motion analysis system

(QualisysTM Medical AB, Goteburg, Sweden)

captured kinematic data at 250 Hz and was

calibrated before each data collection session.

Participants ran at 4.0m/s (±5%) over a force

platform (Kistler, Kistler Instruments Ltd.,)

sampling at 1000 Hz, stance time was determined

as the time over which 20 N or greater of vertical

force was applied to the force platform (Sinclair et

al., 2011). Velocity was controlled using infrared

photocells Newtest 300 (Newtest, Oy Koulukatu

31 B 11 90100 Oulu Finland).

The marker configuration utilized for the

study to record lower limb kinematics was based

on the CAST technique (Cappozzo et al., 1995). In

order to define the anatomical reference frames of

the pelvis, thigh, foot and shank segments; retro-

reflective markers were attached to the 1st and 5th

metatarsal heads, medial and lateral malleoli,

medial and lateral epicondyle of the femur,

greater trochanter of the right leg, iliac crest,

anterior superior iliac spines and posterior

superior iliac spines (Figure 1). Hip joint centre

was determined based on the Bell et al. (1989)

equations via the positions of the PSIS and ASIS

markers.

Two static calibration trials were captured

with the participant standing in the anatomical


by Sinclair J. et al. 17

© Editorial Committee of Journal of Human Kinetics

position. The first static (test) was conducted prior

to the running trials and the anatomical

landmarks were removed. Following completion

of the running trials the anatomical landmarks

were re-positioned and the second static trial

(retest) was obtained. Cluster markers used to

define the technical tracking frame of each

segment remained rigidly in place for the

duration of the analysis and were not removed,

allowing the test-retest reliability of the

anatomical frame to be examined. The tracking

clusters positioned on the pelvis, thigh and shank

were comprised of four 19mm spherical reflective

markers mounted to a thin sheath of lightweight

carbon fiber (Figure 2) with a length to width ratio

of 1.5-1, in accordance with the Cappozzo et al.

(1997) recommendations. The technical frame of

the foot segment was defined using four retro-

reflective markers glued rigidly onto the footwear

(Saucony pro grid guide 2, sizes 7-9 UK). The

same model of footwear was used for all

participants and was selected to represent typical

running footwear.

Figure 1

Pelvic, thigh, tibial and foot segments, with segment co-ordinate system axes.

(P= Pelvis, S= Shank, T= tibia and F = foot)




Figure 2

Carbon fiber tracking clusters as positioned on the a. thigh and shank and b. pelvic segments

Data processing

Motion files from each participant were

applied to both static trials. Kinematic parameters

from static one (Test) and two (Retest) were

quantified using Visual 3-D (C-Motion Inc,

Germantown, USA) and filtered at 10 Hz using a

zero-lag low pass Butterworth 4th order filter. This

was selected as being the frequency at which 95%

of the signal power was below following a fast

fourier transform (FFT) using Labview software

(National instruments, Austin TX). Lower

extremity joint angles were created using an XYZ

cardan sequence of rotations (Sinclair et al., 2012).

All data were normalized to 100% of the stance

phase, then mean processed gait trial data was

reported. 3-D kinematic measures from the hip,

knee and ankle which were extracted for

statistical analysis were 1) angle at footstrike, 2)

angle at toe-off, 3) range of motion from footstrike

to toe-off during stance, 4) peak angle during

stance, 5) peak angular excursion from footstrike

to peak angle 6) velocity at footstrike, 7) velocity

at toe-off and 8) peak velocity.

Analysis

Descriptive statistics including means and

standard deviations were calculated for each

condition. Differences in stance phase kinematic

parameters were examined using paired samples

t-tests with significance accepted at the p≤0.05

level. The Shapiro-wilk statistic for each condition

confirmed that the data were normally

distributed. Intra-class correlations were utilized

to compare test and retest sagittal, coronal and

transverse plane waveforms of the hip, knee and

ankle. All statistical procedures were conducted

using SPSS 19.0 (SPSS Inc, Chicago, USA).

Results

Joint Angles

Figure 3 presents the mean and standard

deviation 3-D angular kinematic waveforms from

of the lower extremities during the stance phase.

Tables 1-3 present 3-D joint angles obtained as a

function of test and retest static trials.

Hip

The results indicate that no significant

(p>0.05) differences in hip joint kinematics in the

sagittal, coronal and transverse planes were

observed between test and retest parameters.

Knee


(p>0.05) differences in knee joint kinematics in the



Ankle


(p>0.05) differences in ankle joint kinematics in

the sagittal, coronal and transverse planes were


Comparisons between pre and post

kinematic waveforms for the hip joint revealed

strong correlations for the sagittal (R2= 0.99),

coronal (R2=0.98) and transverse (R2= 0.96) planes.

For the knee joint strong correlations were

observed in the sagittal (R2= 0.99), coronal

(R2=0.96) and transverse (R2= 0.96) planes. For the

ankle joint strong correlations were observed in

sagittal (R2= 0.96), coronal (R2=0.90) and transverse

(R2= 0.91) planes.




Joint Velocities

Figure 4 presents the mean and standard

deviation 3-D angular kinematic waveforms from

of the lower extremities during the stance phase.

Tables 4-6 present 3-D joint velocities obtained as

a function of test and retest static trials.

Hip


(p>0.05) differences in hip joint velocities in the



Knee


(p>0.05) differences in knee joint velocities in the



Ankle


(p>0.05) differences in ankle joint velocities in the



Figure 3

Mean and standard deviation hip, knee and ankle joint kinematics in the a. sagittal, b. coronal

and c. transverse planes for Test (black line) and Retest (grey line), running

(shaded area is 1 ±SD, Test = grey shade and Retest = horizontal).




Table 1

Hip joint kinematics (means, standard deviations) from the stance limb as a function

of Test and Retest anatomical co-ordinate axes (* = Significant main effect p≤0.05)

Table 2

Knee joint kinematics (means, standard deviations) from the stance limb

as a function of Test and Retest anatomical co-ordinate axes (* = Significant main effect p≤0.05).

Test Retest

Mean difference (°)

Hip X (+ = flexion/ - = extension)

Angle at Footstrike (°) 38.21 ± 3.96 39.11 ± 6.43 0.9 Angle at Toe-off (°) -5.56 ± 6.77 -4.66 ± 6.69 0.9 Range of Motion (°) 43.77 ± 5.91 43.58 ± 6.06 0.19 Relative Range of Motion (°) 0.96 ± 0.97 0.94 ± 0.98 0.02 Peak Flexion (°) 38.73 ± 5.16 40.71 ± 5.12 1.98 Y (+ =adduction/-=abduction)

Angle at Footstrike (°) -2.02 ± 3.96 -2.55 ± 4.84 0.53 Angle at Toe-off (°) -3.82 ± 4.65 -4.40 ± 4.63 0.58 Range of Motion (°) 4.51 ± 2.17 5.01 ± 3.63 0.5 Relative Range of Motion (°) 5.34 ± 3.16 5.38 ± 3.19 0.02 Peak Adduction (°) 3.38 ± 4.90 2.94 ± 5.06 0.44 Z (+=internal /- =external) Angle at Footstrike (°) -5.34 ± 11.36 -7.01 ± 11.71 1.67 Angle at Toe-off (°) -13.42 ± 10.54 -13.58 ± 11.10 0.16 Range of Motion (°) 43.77 ± 5.91 43.58 ± 6.06 0.19 Relative Range of Motion (°) 9.53 ± 3.86 9.70 ± 3.78 0.17 Peak External rotation (°) -13.99 ± 9.08 -15.16 ± 10.20 1.67

Test Retest

Mean

difference (°)

Knee

X (+ = flexion/ - = extension)

Angle at Footstrike (°) 13.88 ± 6.52 14.27 ± 6.72 0.39

Angle at Toe-off (°) 12.99 ± 5.32 13.45 ± 5.92 0.46

Range of Motion (°) 5.67 ± 2.63 5.70 ± 2.56 0.03

Relative Range of Motion (°) 24.70 ± 4.45 24.46 ± 4.44 0.24

Peak Flexion (°) 38.24 ± 3.56 38.87 ± 4.42 0.63

Y (+ =adduction/-=abduction)

Angle at Footstrike (°) 3.33 ± 4.07 2.92 ± 4.03 0.41

Angle at Toe-off (°) 0.89 ± 2.75 0.10 ± 2.91 0.79

Range of Motion (°) 3.58 ± 2.70 3.56 ± 2.70 0.02


Peak Adduction (°) -1.86 ± 4.11 -2.52 ± 4.40 0.66

Z (+ =internal/- =external)

Angle at Footstrike (°) -5.08 ± 4.87 -2.89 ± 6.29 2.19

Angle at Toe-off (°) -5.56 ± 6.77 -4.46 ±6.69 1.1

Range of Motion (°) 3.32 ± 1.50 3.35 ± 1.53 0.03


Peak Internal Rotation (°) 8.46 ± 5.18 10.42 ± 5.96 1.96




Table 3

Ankle joint kinematics (means, standard deviations) from the stance limb as a function


Table 4

Hip joint velocities (means, standard deviations) from the stance limb as a function


Test Retest

Mean difference (°)

Ankle

X (+ =plantar/- =dorsi)


Angle at Toe-off (°) -43.44 ± 3.91 -45.16 ± 3.87 1.72

Range of Motion (°) 28.47 ± 12.67 28.48 ± 12.60 0.01


Peak Dorsiflexion (°) -87.35 ± 3.84 -89.99 ± 4.55 2.64

Y (+ =inversion/ - =eversion)


Angle at Toe-off (°) 0.25 ± 4.97 1.13 ± 5.38 0.88

Range of Motion (°) 5.34 ± 2.22 5.43 ± 2.36 0.09


Peak Eversion (°) -13.24 ± 6.65 -12.33 ± 6.94 0.91

Z (- =internal/+ =external)


Angle at Toe-off (°) -10.42 ± 7.17 -8.30 ± 7.26 2.12

Range of Motion (°) 2.08 ± 1.47 2.43 ± 2.36 0.35


Peak Internal Rotation (°) -2.75 ± 7.63 -0.22 ± 7.17 2.53

Test Retest Mean difference

(Deg.s-1) Hip


Velocity at FootStrike (Deg.S-1) -54.03 ± 95.74 -55.75 ± 94.68 1.72 Velocity at Toe-Off (Deg.S-1) -93.65 ± 76.21 92.19 ± 79.21 1.46 Peak Extension Velocity (Deg.S-1) -419.36 ± 94.91 -417.73 ± 94.25 1.63

Y (+ =adduction/-=abduction)

Velocity at FootStrike (Deg.S-1) 182.88 ± 66.48 183.37 ± 65.84 0.49 Velocity at Toe-Off (Deg.S-1) -21.24 ±58.69 -18.43 ± 58.72 2.81 Peak Abduction Velocity (Deg.S-1) -107.25 ± 36.60 -102.49 ± 38.37 5.26

Z (+=internal /- =external)

Velocity at FootStrike (Deg.S-1) -94.03 ± 67.55 -90.65 ± 76.32 3.38 Velocity at Toe-Off (Deg.S-1) -102.24 ± 68.22 -101.20 ± 68.62 1.04 Peak Internal Rotation Velocity (Deg.S-1) 120.46 ± 42.87 120.60 ± 43.87 0.14




Figure 4

Mean and standard deviation hip, knee and ankle joint velocities in the a. sagittal, b. coronal

and c. transverse planes for Test (black line) and Retest (grey line),

running (shaded area is 1 ±SD, Test = grey shade and Retest = horizontal)

Table 5

Knee joint velocities (means, standard deviations) from the stance limb as a function


Test Retest Mean difference

(Deg.s-1) Knee


Velocity at FootStrike (Deg.S-1) 265.89 ± 89.78 263.81 ± 83.88 2.08 Velocity at Toe-Off (Deg.S-1) 20.05 ± 76.63 16.86 ± 76.64 3.19 Peak Flexion Velocity (Deg.S-1) 397.68 ± 39.85 397.08 ± 61.33 0.6 Peak Extension Velocity (Deg.S-1) -320.42 ± 59.76 -322.36 ± 59.76 1.94 Y (+ =adduction/-=abduction)

Velocity at FootStrike (Deg.S-1) -13.67 ± 62.60 -21.57 ± 75.60 7.9 Velocity at Toe-Off (Deg.S-1) -34.25 ± 30.66 -36.44 ± 28.69 2.19 Peak Adduction Velocity (Deg.S-1) 106.86 ± 39.85 101.46 ± 29.61 5.4 Peak Abduction Velocity (Deg.S-1) -104.20 ± 18.88 -103.07 ± 29.26 1.13 Z (+=internal /- =external)

Velocity at FootStrike (Deg.S-1) 253.64 ± 74.35 252.87 ± 74.08 0.23 Velocity at Toe-Off (Deg.S-1) -43.67 ± 123.92 -43.45 ± 123.90 0.22 Peak External Rotation Velocity (Deg.S-1) -255.83 ± 68.98 -254.56 ± 69.46 1.37




Table 6

Ankle joint velocities (means, standard deviations) from the stance limb as a function


Comparisons between pre and post

kinematic waveforms for the hip joint revealed

strong correlations for the sagittal (R2= 0.99),

coronal (R2=0.99) and transverse (R2= 0.97) planes.

For the knee joint strong correlations were

observed in the sagittal (R2=0.99), coronal (R2=0.99

and transverse R2= 0.92 planes. For the ankle joint

strong correlations were observed in sagittal R2=

0.92, coronal R2=0.90 and transverse R2= 0.87

planes.

Discussion

The aim of the current investigation was

to determine the test-retest reliability of the

segment anatomical reference frame definition. In

the present study, running trials were analysed

simultaneously using two different anatomical co-

ordinate systems. This represents the first study

investigating the test-retest reliability in defining

the lower extremity segment anatomical co-

ordinate system axes and their potential influence

on 3-D kinematic parameters during the stance

phase of running.

The major finding from the current

investigation is that the different anatomical

reference frames obtained from the test and retest

static trials had no significant (p>0.05) effect on 3-

D kinematic parameters. This opposes the

findings of Kabada et al. (1989) who observed that

the angular deviations when examining reliability

were much greater than those observed in the

current study.

It is beyond the latitude of this study to

specify acceptable levels of consistency for 3-D

kinematic information. However, in their review

paper, McGinley et al. (2009) propose that in most

common clinical situations errors of 2° or less are

highly likely to be considered acceptable and

errors of between 2 and 5° are also likely to be

regarded as reasonable. It is proposed that

angular deviations in excess of 5° should be

construed as excessive as they may be sufficient to

misinform clinical analyses. Based on these

recommendations it appears that the technique

utilized in the current investigation is associated

with low levels of error as the majority of test-

retest angular deviations were found to be < 2°.

The intra class correlation analyses

indicate that stance phase kinematic waveforms in

the sagittal plane exhibited very good agreement

(R2≥0.92) between test and retest defined co-

ordinate axes. Furthermore, whilst coronal and

Test Retest

Mean difference (Deg.s-1)

Ankle

X (+ =plantar/- =dorsi)

Velocity at FootStrike (Deg.S-1) 153.18 ± 163.31 153.56 ± 163.36 0.38

Velocity at Toe-Off (Deg.S-1) 466.83 ± 55.41 467.83 ± 56,06 1.0

Peak Plantar Flexion Velocity (Deg.S-1) 739.35 ± 75.40 738.11 ± 75.74 1.24

Peak Dorsi Flexion Velocity (Deg.S-1) -366.96 ± 116.45 -366.91 ± 115.68 0.05

Y (+ =inversion/ - =eversion)

Velocity at FootStrike (Deg.S-1) -195.08 ± 41.31 -194.45 ± 41.08 0.63

Velocity at Toe-Off (Deg.S-1) 180.20 ± 75.05 179.87 ± 71.69 0.33

Peak Inversion Velocity (Deg.S-1) 242.21 ± 66.95 240.51 ± 62.23 1.7

Peak Eversion Velocity (Deg.S-1) -304.89 ± 63.17 -303.18 ± 61.95 1.71

Z (- =internal/+ =external)

Velocity at FootStrike (Deg.S-1) -46.14 ± 20.17 -47.69 ± 21.43 1.55

Velocity at Toe-Off (Deg.S-1) -23.18 ± 68.83 -13.10 ± 69.36 10.08

Peak Internal Rotation Velocity (Deg.S-1) -164.33 ± 17.19 -173.12 ± 20.15 8.79

Peak External Rotation Velocity (Deg.S-1) 154.44 ± 31.96 156.64 ±34.70 2.2




transverse plane waveforms also exhibited good

agreement the conformity (R2 ≥0.87) was lower

than those observed in the sagittal plane. This

concurs with the findings of Kabada et al. (1989)

who noted that coronal and transverse plane

angles were affected more pointedly than the

sagittal plane profiles by differences in anatomical

frame axes definition.

The lowest correlations between test and

retest waveforms were observed for ankle joint

parameters in all three anatomical planes. It is

proposed that this relates to the fact that the

anatomical co-ordinate system axes of the foot

were defined by placing markers directly onto the

shoe which has been identified as problematic.

This is because it is more difficult to palpate non

visible landmarks through the shoe. Furthermore,

there is almost a certain movement of the foot

within the shoe (Stacoff et al., 1992), thus it is

questionable as to whether anatomical markers

located on the shoe provide comparable results to

those placed on the foot itself. Future studies may

wish to re-examine the reliability of anatomical

frame definition when placing markers directly

onto the foot.

With the aim of increasing the efficacy

and reliability of 3-D kinematic data, researchers

have also developed methods of quantifying

segmental axes of rotation that are independent of

anatomical landmarks. The most common is the

functional method of identifying segmental

parameters has been proposed as an effective way

to reduce the proposed variability of anatomical

definitions (Besier et al., 2003; Della Croce et al.,

1999). However, the use of markerless technology

to record 3-D kinematics is still a minority

technique (Richards and Thewlis, 2008) and has

been limited by the intricacy of obtaining precise

3-D kinematics using this approach (Corazza et

al., 2006). Future research may wish to replicate

the current investigation using markerless

anatomical frame definition to further examine

the efficacy of this technique.

The fact that this paper focused solely on

3-D angulation and angular velocities is

potentially a limitation of the current

investigation. Future investigations should focus

on additional kinetic parameters such as joint

moments which may be influenced by differences

in anatomical frame definition (Thewlis et al.,

2008). Joint moments have strong sporting and

clinical significance and may also be influenced

by variations in the anatomical frame thus it is

important to also consider their reliability. Finally,

care should be taken when attempting to

generalize the findings of this study to

investigations examining pathological kinematics.

It is likely that variations will exist in the relative

contributions of the sources of measurement error

in participants who exhibit an abnormal gait

pattern (Gorton et al., 2009). For participants with

skeletal alignment pathologies, palpation and

subsequent marker placement may be more

complex and result in reduced reliability (Gorton

et al., 2009).

In conclusion, based on the results

obtained from the methodologies used in the

current investigation, it appears that the

anatomical co-ordinate axes of the lower

extremities can be defined reliably. Future

research should focus on the efficacy and

advancement of markerless techniques.

Acknowledgements

Our thanks go to Glen Crook for his technical assistance.

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Sinclair J, Hobbs SJ, Edmundson CJ, Brooks D. Evaluation of kinematic methods of identifying foot strike

and toe-off during running, Int J Sp Sci and Eng, 2011; 5: 188-192

Stacoff A, Reinschmidt C, Stüssi E. The movement of the heel within a running shoe. Med Sci Sport Exer,

1992; 24: 695-701

Thewlis D, Richards J, Bower J. Discrepancies in Knee Joint Moments Using Common Anatomical Frames

Defined by Different Palpable Landmarks, J App Biomech, 2008; 24: 185-190

Corresponding author:

Jonathan Sinclair,

Division of Sport, Exercise and Nutritional Sciences

University of Central Lancashire, Preston

Lancashire, PR1 2HE.

E-mail: [email protected]


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